Organizational Assessment 2020 Survey

CNM, The Healing Trust, HCA Foundation, and the Dan & Margaret Maddox Charitable Fund are partnering with Crossroads Antiracism Organizing & Training to provide a two and a half day workshop that is meant to help participants transform organizational and personal practices and learn how to create and sustain racially equitable practices. At the end of this workshop, organizations will have practical strategies to implement equitable practices and dismantle racism in their work.

This workshop is designed for teams of four, which can include the CEO/ED, a board member, staff members, volunteers, or anyone else who is associated with your organization. To maximize the opportunity, there will be no more than 11 teams (44 total participants) in the workshop. Scholarships are available on a sliding scale.

This course will have 1-2 hours of pre-reading to complete, as well as reflection between each session. Please be prepared for these additional requirements to the session.

If you have any questions, please reach out to training@cnm.org.

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* 1. Organization Name

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* 2. Organization Budget (estimated from the most recent fiscal year)

$0 to $49,999

$50,000 to $99,999

$100,000 to $299,999

$300,000 to $499,999

$500,000 to $999,999

$1,000,000 to $1,999,999

$2,000,000 to $4,999,999

$5,000,000 and up

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* 3. Please select your preferred training dates.

April

Oct

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* 4. Has your organization, staff, or board attended any courses of systemic racism before? This can be a course with CNM or any other organization. It is not a requirement to attend a course previously, but is highly recommended.

Not sure

Yes (please specify course and organizational role of person who participated)

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* 5. Would your organization like to be considered for scholarship to help cover part of the workshop cost?

Yes, our organization is interested in a scholarship.

No, our organization does not need financial assistance at this time.

Other (please specify)

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* 6. Please check the following if your organization is a current grantee. Check all that apply.

Dan & Margaret Maddox Charitable Fund

HCA Foundation

Healing Trust

None of the above

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* 7. Who is the primary contact for this event?

This person will be in communications with CNM about next steps in the process. They may or may not be participating in the session. They will ensure that all team members complete the pre-assignments. CNM will send all communications, including invoices, to this person.

First and Last Name:

Job Title:

Primary Email Address:

Primary Phone Number:

Mailing Address for the Organization:

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* 8. Participant 1 Contact Information

First and Last Name:

Job Title or Role:

Email Address:

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* 9. Participant 2 Contact Information

First and Last Name:

Job Title or Role:

Email:

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* 10. Participant 3 Contact Information

First and Last Name:

Job Title or Role:

Email Address:

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* 11. Participant 4 Contact Information

First and Last Name:

Job Title or Role:

Email Address:

Organizational Assessment 2020

Contact Information

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* 1. Organization Name

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* 2. Organization Budget (estimated from the most recent fiscal year)

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* 3. Please select your preferred training dates.

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* 4. Has your organization, staff, or board attended any courses of systemic racism before? This can be a course with CNM or any other organization. It is not a requirement to attend a course previously, but is highly recommended.

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* 5. Would your organization like to be considered for scholarship to help cover part of the workshop cost?

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* 6. Please check the following if your organization is a current grantee. Check all that apply.

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* 8. Participant 1 Contact Information

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* 9. Participant 2 Contact Information

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* 10. Participant 3 Contact Information

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* 11. Participant 4 Contact Information

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* 12. How does systemic racism manifest itself in your practice or organization? (1-3 sentences)

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* 13. What challenges are your organization facing in achieving these goals? (1-3 sentences)

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* 14. Name at least one long-term and one short-term goal you have to advance racial equity in your organization.

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* 15. Please share anything else you'd like the facilitators to know.